One of the big, unanswered questions about Obamacare is what impact it’s having on the uninsured. A series of surveys, by Gallup, the RAND Corporation, and the Urban Institute have suggested the number and proportion of Americans without coverage is declining. But by how much? Those surveys are necessarily imprecise. We won’t have more definitive data until late this year, when the federal government starts publishing its survey information. And even that will be tentative.
But we’re starting to get more information from other sources. One is a new study of how the Affordable Care Act has played out in one state: Minnesota. The study, underwritten by the Robert Wood Johnson Foundation, comes from the State Health Access Data Assistance Center at the University of Minnesota. It’s based on information from insurance programs and carriers, which makes it more reliable than regular surveys of individuals.
Its main finding? The number of people without health insurance fell from about 445,000 to 264,000. That’s roughly a 40 percent decline in the number of uninsured, lowering the state’s overall rate from 8.2 percent to 4.8 percent. That looks a lot like what happened in Massachusetts after similar reforms passed there, and it's right in line with what Congressional Budget Office has predicted for the country as a whole. (Whether it's bigger or smaller depends on which metric you want to use. CBO predicts the number of people without insurance in 2014 will be 42 million, relative to 54 million under prior law.)
“Our findings are consistent with reports of early national impacts of the ACA showing a decline in the number of uninsured and also with the experience of Massachusetts, which implemented similar reforms in 2007,” Julie Sonier, lead author on the report, said in a prepared statement. “We know that the ACA’s impacts will vary by state, and encourage other states to examine their own shifts in health insurance coverage to see who’s gaining coverage and what lessons they can take away for the fall open enrollment period.”
Naturally, the finding comes with caveats. Making sure the uninsured have coverage is just one of the law's goals, albeit an important one. This study doesn't tell us whether these people are getting better medical care or enjoying more financial security, although the best available research suggests that both things will happen.
The baseline number is from September 30, before the new marketplaces opened for business. It’s not clear whether a baseline that looked at the uninsured rate in May of 2013 would have produced the same result. And a big reason for the decline in Minnesota was the high enrollment in Medicaid, which Minnesota lawmakers enthusiastically agreed to expand. In about half of the country, more conservative lawmakers have blocked their states from undertaking similar changes.
Of course, that’s a pretty powerful demonstration of the benefits that these conservative officials are denying to their citizens.